eMedicine Specialties > Pediatrics: General Medicine > Allergy & Immunology

Thymoma: Follow-up

Author: Richard A Bickel, MD, Fellow in Allergy/Immunology, Walter Reed Army Medical Center
Coauthor(s): Cecilia P Mikita, MD, MPH, Assistant Professor of Pediatrics and Medicine, Uniformed Services University of the Health Sciences; Associate Program Director of Allergy-Immunology Fellowship, Chief of Clinical Services, Staff Allergist/Immunologist, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Dec 12, 2008

Follow-up

Complications

  • Structural problems, such as compression syndromes that involve the bronchi or lungs or superior vena cava syndrome (SVCS), can occur from local spread of benign thymoma, from thymic cysts, or from thymic carcinoma. Presenting symptoms may include chest pain, SVCS, dyspnea, dysphagia, and cough.
  • Areas of benign thymoma can become highly vascular or necrotic and lead to bleeding.
  • Clinical manifestations include paraneoplastic syndromes and immunodeficiency.

Prognosis

  • See Pathophysiology.
  • Adverse predictive factors include the following:38,39
    • Invasive or metastatic tumor
    • Tracheal or vascular compression
    • Age younger than 30 years
    • Epithelial or mixed histology
    • Tumor size of more than 8 cm40
  • The presence of myasthenia gravis (MG) with thymomas is no longer considered a poor prognostic factor and is actually thought to be a favorable prognostic factor.41
  • Based on WHO classification, the 5-year and 10-year survival rates are as follows:42,43
    • Type A - 100% and 95%, respectively
    • Type AB - 93% and 90%, respectively
    • Type B1 - 89% and 85%, respectively
    • Type B2 - 82% and 71%, respectively
    • Type B3 - 71% and 40%, respectively
    • Type C - 23% (5-year survival rate)
  • Recurrence of thymoma can occur after resection. A study surgical outcomes after recurrence of thymic epithelial tumors in 67 patients showed an overall survival rate at 10 years of 70% in those undergoing re-resection.29
  • For patients with Masaoka stage IVA thymomas, a study of 18 patients reported survival rates at 3 years (91%), 5 years (78%), and 10 years (65%).44 These patients underwent multimodality therapy, including surgical resection, preoperative chemotherapy, and even postoperative radiation therapy (in select patients).

Miscellaneous

Medicolegal Pitfalls

  • The usual medicolegal pitfalls apply to thymoma and its related conditions, including myasthenia gravis (MG), with regard to misdiagnosis or delayed diagnosis. Medication adverse effects and surgical complications may also increase the medicolegal risk associated with evaluation and management of this disorder.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Marion Johnson, MD, to the development and writing of this article.



More on Thymoma

Overview: Thymoma
Differential Diagnoses & Workup: Thymoma
Treatment & Medication: Thymoma
Follow-up: Thymoma
References
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Further Reading

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Keywords

thymoma, lymphoepithelioma, neoplasm of thymic epithelial cells, myasthenia gravis, MG, Lambert-Eaton myasthenic syndrome, LEMS, subacute sensory neuronopathy, red cell aplasia, immunodeficiency, Good syndrome, thymic epithelial tumor, TET, neuromyotonia, limbic encephalitis, polymyositis, subacute hearing loss, psychosis, sleep disorders, common variable immunodeficiency, CVID, superior vena cava syndrome, SVCS, mucocutaneous candidiasis, recurrent herpes simplex virus, varicella-zoster virus, cytomegalovirus, Pneumocystis carinii pneumonia, compression syndrome

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Contributor Information and Disclosures

Author

Richard A Bickel, MD, Fellow in Allergy/Immunology, Walter Reed Army Medical Center
Richard A Bickel, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Cecilia P Mikita, MD, MPH, Assistant Professor of Pediatrics and Medicine, Uniformed Services University of the Health Sciences; Associate Program Director of Allergy-Immunology Fellowship, Chief of Clinical Services, Staff Allergist/Immunologist, Walter Reed Army Medical Center
Cecilia P Mikita, MD, MPH is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and Clinical Immunology Society
Disclosure: Nothing to disclose.

Medical Editor

Terry Chin, MD, PhD, Associate Professor of Pediatrics, Pediatric Allergy/Immunology/Pulmonology, Department of Pediatrics, University of California Irvine School of Medicine; Associate Director, Miller Children's Hospital at Long Beach Memorial Medical Center
Terry Chin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, California Thoracic Society, Clinical Immunology Society, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

David J Valacer, MD, Consulting Staff, Hoffman La Roche Pharmaceuticals
David J Valacer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American Thoracic Society, and New York Academy of Sciences
Disclosure: Nothing to disclose.

CME Editor

David Pallares, MD, Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville
David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology
Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD, Associate Professor, Division of Pulmonary Allergy/Immunology and Infectious Diseases, Department of Pediatrics, UMDNJ-New Jersey Medical School
Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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